Provider Demographics
NPI:1255722914
Name:NIX, LAKEN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LAKEN
Middle Name:
Last Name:NIX
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 HELEN KELLER BLVD
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-2963
Mailing Address - Country:US
Mailing Address - Phone:205-344-6169
Mailing Address - Fax:204-344-6171
Practice Address - Street 1:661 HELEN KELLER BLVD
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-2963
Practice Address - Country:US
Practice Address - Phone:205-344-6169
Practice Address - Fax:204-344-6171
Is Sole Proprietor?:No
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3559235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist